1
|
Lawford BJ, Bennell KL, Hall M, Egerton T, McManus F, Lamb KE, Hinman RS. Effect of Information Content and General Practitioner Recommendation to Exercise on Treatment Beliefs and Intentions for Knee Osteoarthritis: An Online Multi-Arm Randomized Controlled Trial. ACR Open Rheumatol 2022; 5:17-27. [PMID: 36444919 PMCID: PMC9837392 DOI: 10.1002/acr2.11513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/27/2022] [Accepted: 10/12/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To evaluate effects of general osteoarthritis (OA) information in addition to a treatment option grid and general practitioner (GP) recommendation to exercise on treatment beliefs and intentions. METHODS An online randomized trial of 735 people 45 years old or older without OA who were recruited from a consumer survey network. Participants read a hypothetical scenario about visiting their GP for knee problems and were randomized to the following: i) 'general information', ii) 'option grid' (general information plus option grid), or iii) 'option grid plus recommendation' (general information plus option grid plus GP exercise recommendation). The primary outcome was an agreement that exercise is the best management option (0-10 numeric rating scale; higher scores indicating higher agreement that exercise is best). The secondary outcomes were beliefs about other management options and management intentions. Linear regression models estimated the mean (95% confidence interval [CI]) between-group difference in postintervention scores, adjusted for baseline. RESULTS Option grid plus recommendation led to higher agreement that exercise is the best management by a mean of 0.4 units (95% CI: 0.1-0.6) compared with general information. There were no other between-group differences for the primary outcome. Option grid led to higher agreement that surgery was best, and x-rays were necessary, compared with general information (mean between-group differences: 0.7 [CI: 0.2-1.1] and 0.5 [CI: 0.1-1.0], respectively) and option grid plus recommendation (0.5 [CI: 0.1-0.9] and 0.9 [CI: 0.4-1.3]). CONCLUSION Addition of an option grid and GP exercise recommendation to general OA information led to more favorable views that exercise was best for the hypothetical knee problem. However, differences were small and of unclear clinical importance.
Collapse
|
2
|
Morrison T, Foster E, Dougherty J, Barton J. Shared Decision Making in Rheumatology: A Scoping Review. Semin Arthritis Rheum 2022; 56:152041. [DOI: 10.1016/j.semarthrit.2022.152041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
|
3
|
Gaskin DJ, Karmarkar TD, Maurer A, Bucay‐Harari L, Casillas G, Gittens A, Jones LC, Thorpe RJ, Tolbert E, Wood JE. Potential Role of Cost and Quality of Life in Treatment Decisions for Arthritis‐Related Knee Pain in African American and Latina Women. Arthritis Care Res (Hoboken) 2020; 72:692-698. [DOI: 10.1002/acr.23903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 04/09/2019] [Indexed: 12/31/2022]
|
4
|
Smith S, Alvand A, Locock L, Ryan S, Smith J, Bayliss L, Wilson H, Price A. Partial or total knee replacement? Identifying patients' information needs on knee replacement surgery: a qualitative study to inform a decision aid. Qual Life Res 2019; 29:999-1011. [PMID: 31848846 PMCID: PMC7142054 DOI: 10.1007/s11136-019-02381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 11/27/2022]
Abstract
Purpose For patients with end-stage knee osteoarthritis, joint replacement is a widely used and successful operation to help improve quality-of-life when non-operative measures have failed. For a significant proportion of patients there is a choice between a partial or total knee replacement. Decision aids can help people weigh up the need for and benefits of treatment against possible risks and side-effects. This study explored patients’ experiences of deciding to undergo knee replacement surgery to identify information priorities, to inform a knee replacement decision aid. Methods Four focus groups were held with 31 patients who were candidates for both partial and total knee replacement surgery. Two focus groups included patients with no prior knee replacement surgery (pre-surgery); two with patients with one knee already replaced and who were candidates for a second surgery on their other knee (post-surgery). Data were analysed using Framework Analysis. Results Participants described a process of arriving at ‘readiness for surgery’ a turning point where the need for treatment outweighed their concerns. Referral and personal factors influenced their decision-making and expectations of surgery in the hope to return to a former self. Those with previous knee surgery offered insights into whether their expectations were met. ‘Information for decisions’ details the practicality and the optimal timing for the delivery of a knee replacement decision aid. In particular, participants would have valued hearing about the experiences of other patients and seeing detailed pictures of both surgical options. Information priorities were identified to include in a decision aid for knee replacement surgery. Conclusions Patients’ experiences of surgical decision-making have much in common with the Necessity-Concerns Framework. Whilst originally developed to understand drug treatment decisions and adherence, it provides a useful lens to understand decision-making about surgery. The use of a decision aid could enhance decision-making on knee replacement surgery. Ultimately, patients’ understanding of the risks and benefits of both surgical options could be improved and in turn, help informed decision-making. The knee replacement decision aid is perceived as a useful tool to be associated with other detailed information resources as recommended. Electronic supplementary material The online version of this article (10.1007/s11136-019-02381-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stephanie Smith
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Ryan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Smith
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.,Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Lee Bayliss
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Hannah Wilson
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Abstract
New technologies can do more than just digitize health information; they can support multimedia platforms for patient education and health decision support. Technology can simplify the way health decisions are made by offering quick access to a vast amount of information that can be tailored to specific populations. Digital tools can increase knowledge and assist consumers in comparing health care alternatives. They are well received by patients because of the myriad features that render them visually appealing and entertaining, including audiovisual and interactive elements. To be effective, however, digital tools must be evidence based and developed following quality standards.
Collapse
|
6
|
Scalia P, Elwyn G, Durand MA. "Provoking conversations": case studies of organizations where Option Grid™ decision aids have become 'normalized'. BMC Med Inform Decis Mak 2017; 17:124. [PMID: 28821256 PMCID: PMC5562992 DOI: 10.1186/s12911-017-0517-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022] Open
Abstract
Background Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Method Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholders were conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota. Results ‘Coherent’ motivations were guided by financial incentives at CapitalCare, and by a ‘champion’ physician at HealthPartners. Nurses worked ‘collectively’ at both settings and played an important role at sites where successful implementation occurred. Some physicians did not understand the perceived utility of Option Grid™, which led to varying degrees of implementation success across sites. The appraisal work (reflexive monitoring) identified benefits, particularly in terms of information provision. Physicians at both settings, however, were concerned with time pressures and the suitability of the tool for patients with low levels of health literacy. Conclusion Although both practice settings illustrated the mechanisms of normalization postulated by the theory, the extent to which Option Grid™ was routinely embedded in clinic workflow varied between sites, and between clinicians. Implementation of new interventions will require attention to an identified rationale (coherence), and to the collective action, cognitive participation, and assessment of value by organizational members of the organization. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0517-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA
| |
Collapse
|
7
|
Kinsey K, Firth J, Elwyn G, Edwards A, Brain K, Marrin K, Nye A, Wood F. Patients' views on the use of an Option Grid for knee osteoarthritis in physiotherapy clinical encounters: An interview study. Health Expect 2017; 20:1302-1310. [PMID: 28779512 PMCID: PMC5689238 DOI: 10.1111/hex.12570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 12/01/2022] Open
Abstract
Background Patient decision support tools have been developed as a means of providing accurate and accessible information in order for patients to make informed decisions about their care. Option Grids™ are a type of decision support tool specifically designed to be used during clinical encounters. Objective To explore patients’ views of the Option Grid encounter tool used in clinical consultations with physiotherapists, in comparison with usual care, within a patient population who are likely to be disadvantaged by age and low health literacy. Methods Semi‐structured interviews with 72 patients (36 who had been given an Option Grid in their consultation and 36 who had not). Thematic analysis explored patients’ understanding of treatment options, perceptions of involvement, and readability and utility of the Option Grid. Results Interviews suggested that the Option Grid facilitated more detailed discussion about the risks and benefits of a wider range of treatment options for osteoarthritis of the knee. Participants indicated that the Option Grid was clear and aided their understanding of a structured progression of the options as their condition advanced, although it was not clear whether the Option Grid facilitated greater engagement in shared decision making. Discussion and conclusion The Option Grid for osteoarthritis of the knee was well received by patient participants who reported that it helped them to understand their options, and made the notion of choice explicit. Use of Option Grids should be considered within routine consultations.
Collapse
Affiliation(s)
| | - Jill Firth
- Pennine MSK Partnership Ltd, Greater Manchester, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth, NH, USA
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Katherine Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Katy Marrin
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Alan Nye
- Pennine MSK Partnership Ltd, Greater Manchester, UK
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
8
|
Wood F, Phillips K, Edwards A, Elwyn G. Working with interpreters: The challenges of introducing Option Grid patient decision aids. PATIENT EDUCATION AND COUNSELING 2017; 100:456-464. [PMID: 27745941 DOI: 10.1016/j.pec.2016.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/15/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We aimed to observe how an Option Grid™ decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. METHODS Data were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. RESULTS Analysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. CONCLUSION Patients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. PRACTICE IMPLICATIONS Option Grid decision aids are not being used as intended in interpreted consultations.
Collapse
Affiliation(s)
- Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.
| | - Katie Phillips
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover NH USA
| |
Collapse
|
9
|
Selten EMH, Geenen R, van der Laan WH, van der Meulen-Dilling RG, Schers HJ, Nijhof MW, van den Ende CHM, Vriezekolk JE. Hierarchical structure and importance of patients' reasons for treatment choices in knee and hip osteoarthritis: a concept mapping study. Rheumatology (Oxford) 2016; 56:271-278. [PMID: 27864564 DOI: 10.1093/rheumatology/kew409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 10/11/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To improve patients' use of conservative treatment options of hip and knee OA, in-depth understanding of reasons underlying patients' treatment choices is required. The current study adopted a concept mapping method to thematically structure and prioritize reasons for treatment choice in knee and hip OA from a patients' perspective. METHODS Multiple reasons for treatment choices were previously identified using in-depth interviews. In consensus meetings, experts derived 51 representative reasons from the interviews. Thirty-six patients individually sorted the 51 reasons in two card-sorting tasks: one based on content similarity, and one based on importance of reasons. The individual sortings of the first card-sorting task provided input for a hierarchical cluster analysis (squared Euclidian distances, Ward's method). The importance of the reasons and clusters were examined using descriptive statistics. RESULTS The hierarchical structure of reasons for treatment choices showed a core distinction between two categories of clusters: barriers [subdivided into context (e.g. the healthcare system) and disadvantages] and outcome (subdivided into treatment and personal life). At the lowest level, 15 clusters were identified of which the clusters Physical functioning, Risks and Prosthesis were considered most important when making a treatment decision for hip or knee OA. CONCLUSION Patients' treatment choices in knee and hip OA are guided by contextual barriers, disadvantages of the treatment, outcomes of the treatment and consequences for personal life. The structured overview of reasons can be used to support shared decision-making.
Collapse
Affiliation(s)
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht
| | | | | | - Henk J Schers
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen
| | - Marc W Nijhof
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | | |
Collapse
|
10
|
Barker D, McElduff P, D'Este C, Campbell MJ. Stepped wedge cluster randomised trials: a review of the statistical methodology used and available. BMC Med Res Methodol 2016; 16:69. [PMID: 27267471 PMCID: PMC4895892 DOI: 10.1186/s12874-016-0176-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous reviews have focussed on the rationale for employing the stepped wedge design (SWD), the areas of research to which the design has been applied and the general characteristics of the design. However these did not focus on the statistical methods nor addressed the appropriateness of sample size methods used.This was a review of the literature of the statistical methodology used in stepped wedge cluster randomised trials. METHODS Literature Review. The Medline, Embase, PsycINFO, CINAHL and Cochrane databases were searched for methodological guides and RCTs which employed the stepped wedge design. RESULTS This review identified 102 trials which employed the stepped wedge design compared to 37 from the most recent review by Beard et al. 2015. Forty six trials were cohort designs and 45 % (n = 46) had fewer than 10 clusters. Of the 42 articles discussing the design methodology 10 covered analysis and seven covered sample size. For cohort stepped wedge designs there was only one paper considering analysis and one considering sample size methods. Most trials employed either a GEE or mixed model approach to analysis (n = 77) but only 22 trials (22 %) estimated sample size in a way which accounted for the stepped wedge design that was subsequently used. CONCLUSIONS Many studies which employ the stepped wedge design have few clusters but use methods of analysis which may require more clusters for unbiased and efficient intervention effect estimates. There is the need for research on the minimum number of clusters required for both types of stepped wedge design. Researchers should distinguish in the sample size calculation between cohort and cross sectional stepped wedge designs. Further research is needed on the effect of adjusting for the potential confounding of time on the study power.
Collapse
Affiliation(s)
- D Barker
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - P McElduff
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - C D'Este
- School of Medicine and Public Health, Faculty of Health, CCEB, HMRI Building, Level 4 West, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, 0200, Australia
| | - M J Campbell
- Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK
| |
Collapse
|
11
|
Elwyn G, Pickles T, Edwards A, Kinsey K, Brain K, Newcombe RG, Firth J, Marrin K, Nye A, Wood F. Supporting shared decision making using an Option Grid for osteoarthritis of the knee in an interface musculoskeletal clinic: A stepped wedge trial. PATIENT EDUCATION AND COUNSELING 2016; 99:571-577. [PMID: 26566194 DOI: 10.1016/j.pec.2015.10.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate whether introducing tools, specifically designed for use in clinical encounters, namely Option Grids, into a clinical practice setting leads to higher levels of shared decision making. METHODS A stepped wedge trial design where 6 physiotherapists at an interface clinic in Oldham, UK, were sequentially instructed in how to use an Option Grid for osteoarthritis of the knee. Patients with suspected or confirmed osteoarthritis of the knee were recruited, six per clinician prior to instruction, and six per clinician afterwards. We measured shared decision making, patient knowledge, and readiness to decide. RESULTS A total of 72 patients were recruited; 36 were allocated to the intervention group. There was an 8.4 point (95% CI 4.4 to 12.2) increase in the Observer OPTION score (range 0-100) in the intervention group. The mean gain in knowledge was 0.9 points (score range 0-5, 95% CI, 0.3 to 1.5). There was no increase in encounter duration. CONCLUSION Shared decision making increased when clinicians used the knee osteoarthritis Option Grid. PRACTICE IMPLICATIONS Tools designed to support collaboration and deliberation about treatment options lead to increased levels of shared decision making.
Collapse
Affiliation(s)
- Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA.
| | - Tim Pickles
- South East Wales Trials Unit, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Katharine Kinsey
- Pennine MSK Partnership Ltd., Integrated Care Centre, Oldham, UK
| | - Kate Brain
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Robert G Newcombe
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Jill Firth
- Pennine MSK Partnership Ltd., Integrated Care Centre, Oldham, UK
| | - Katy Marrin
- Independent Research and Evaluation Consultant, Cardiff, UK
| | - Alan Nye
- Pennine MSK Partnership Ltd., Integrated Care Centre, Oldham, UK
| | - Fiona Wood
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| |
Collapse
|
12
|
Fay M, Grande SW, Donnelly K, Elwyn G. Using Option Grids: steps toward shared decision-making for neonatal circumcision. PATIENT EDUCATION AND COUNSELING 2016; 99:236-242. [PMID: 26324111 DOI: 10.1016/j.pec.2015.08.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement. METHODS We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention. RESULTS Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process. CONCLUSIONS Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making. PRACTICE IMPLICATIONS Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice.
Collapse
Affiliation(s)
- Mary Fay
- Dartmouth Hitchcock Medical Center, Lebanon, USA; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, USA.
| | - Stuart W Grande
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA.
| | - Kyla Donnelly
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA.
| |
Collapse
|
13
|
Conner-Spady BL, Marshall DA, Hawker GA, Bohm E, Dunbar MJ, Frank C, Noseworthy TW. You'll know when you're ready: a qualitative study exploring how patients decide when the time is right for joint replacement surgery. BMC Health Serv Res 2014; 14:454. [PMID: 25278186 PMCID: PMC4283088 DOI: 10.1186/1472-6963-14-454] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/09/2014] [Indexed: 12/28/2022] Open
Abstract
Background While some studies have identified patient readiness as a key component in their decision whether to have total joint replacement surgery (TJR), none have examined how patients determine their readiness for surgery. The study purpose was to explore the concept of patient readiness and describe the factors patients consider when assessing their readiness for TJR. Methods Nine focus groups (4 pre-surgery, 5 post-surgery) were held in four Canadian cities. Participants had been either referred to or seen by an orthopaedic surgeon for TJR or had undergone TJR. The method of analysis was qualitative thematic analysis. Results There were 65 participants, 66% female and 34% male, 80% urban, with an average age of 65 years (SD 10). Readiness reflected both the surgeon’s advice that the patient was clinically ready for surgery and the patient’s feeling that they were both mentally and physically ready for surgery. Mental readiness was described as an internal state or feeling of being ready or prepared while physical readiness was described as being physically fit and in good shape for surgery. Factors associated with readiness included: 1) pain: its severity, the ability to cope with it, and how it affected their quality of life; 2) mental preparation; 3) physical preparation; 4) the optimal timing of surgery, including age, anticipated rate of deterioration, prosthesis lifespan and the length of the waiting list. Conclusions Patient readiness should be assessed prior to TJR. By assessing patient readiness, health professionals can elucidate and deal with concerns and fears, understand and calibrate expectations, assess coping strategies, and use this information to help determine optimal timing, both before and after the surgical consultation.
Collapse
Affiliation(s)
- Barbara L Conner-Spady
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada.
| | | | | | | | | | | | | |
Collapse
|